Cayuga Medical Center at Ithaca Cayuga Medical Center Winter 2013 great! Cayuga Medical Center Cayuga Medical Center at Ithaca The News Magazine of Cayuga Medical Center at Ithaca Winter 2013 Senior Leadership Team John Rudd President and CEO John Collett Chief Operating Officer Lloyd Darlow, MD Vice President Clinical Integration Ellen Dugan Vice President Service Lines Aids Ride for Life 2010 David Evelyn, MD Vice President Medical Affairs Susan Nohelty, RN Vice President Patient Services Alan Pedersen Vice President Human Resources John W. Turner Vice President Public Relations Tony Votaw Vice President and Chief Information Officer Published by the Office of Public Relations John W. Turner Vice President Elizabeth Heath Public Relations Specialist Carol Grassi Public Relations Specialist Tanya Roberts Administrative Assistant Writing and Project Management Julia C. Bonney Principal Photography Dede Hatch Design Terry Marcus Design Health Visions Cayuga Medical Center 101 Dates Drive Ithaca, New York 14850 (607) 274-4011 www.cayugamed.org PRINTED ON RECYCLED PAPER Contents 1Onward! A discussion with our new president and CEO, John Rudd 6 Born to Run Marathon track star Lizzy Jewiss shines with the help of the Endurance Sports Performance Lab 8 A Tale of Two Thumbs Local hand care gets two thumbs up from Nancy Eischen Page 6 12 Fighting Back against Heart Attack Shawn Bell, young husband and father, tells his story 16 Still Cookin’! Local chef Kristof Ostlund goes “diving” to heal his wounds 20 Navigating the Local Health-Care System Finding your way with the help of friendly experts 24 Bringing It All Together through Clinical Integration To improve physical health and fiscal health 28 Cayuga Medical Center Updates 29 House Calls: David Monacelli, MD Reconstructive surgery following mastectomy Page 8 Page16 Onward! In this issue of Health Visions we are pleased to welcome president and CEO John Rudd, who assumed his new role on January 1, 2013. He has been a member of the Cayuga Medical Center family for the past seventeen years. We are proud of his many accomplishments and look forward to continued growth under his skillful leadership. J ohn Rudd was no stranger to Ithaca when he m0ved here with his young family in 1996 to become the medical center’s chief financial officer under president and CEO Bonnie Howell. Having lived first near Corning and then Syracuse, John came to love this region from many family boating trips and then bicycle trips around the Finger Lakes as a teenager. Among the attractions of Ithaca were the numerous outdoor activities available here, including sailing on beautiful Cayuga Lake. His passion for sailing and cycling continues to this day: he sails out of the Ithaca Yacht Club and rides regularly with a group of friends from the medical center and the community. He rode in the first AIDS Ride for Life fourteen years ago and has participated in many subsequent rides. Rudd and his wife, Beverly Chin, have two children, Kirstin and Alec. Beverly works for the Tompkins County Health Planning Council, a program of the Human Services Coalition. She is the Health Planning Council access coordinator and has been active in the development of important local health-care initiatives, such as Urgent Rx. Kirstin, a recent Bucknell University graduate in neuroscience, is working as a research assistant at Harvard Medical School. Alec is completing his senior year at Rensselaer Polytechnic Institute (RPI), majoring in mechanical engineering with a special interest in robotics. Health Visions sat down to talk with John Rudd in late December. When you address employee forums and community groups you inevitably refer to the medical center’s core values. Can you talk about how these values inform your approach as president and CEO? Our five core values (our people, customer service, clinical quality and patient safety, fiscal integrity, our community) help us maintain the balanced approach we need to achieve our mission, which is to deliver the highest-quality health care in partnership with our community, one person at a time. In our day-today work, and as we plan for the future, our programs and services must pass the litmus test of supporting these core values. www.cayugamed.org 1 While all five core values are critical, first and foremost must be clinical quality and patient safety. This value is the bedrock that ensures our patients are at the center of everything we do. We are only able to provide patient-centered care by supporting our people. This incredible team of staff, physicians, and volunteers makes all the difference in the care we provide. Our focus on customer service allows us to ensure that Members of the administrative team at Cayuga Medical Center make rounds every week to connect with everyone we serve has the best employees and physicians. Rudd speaks with Carol Olcott, RN, in the Same-day Surgery Center. possible experience as we strive to meet our mission. Our commitment to fiscal integrity drives our ability that our employees and physicians care First and most important I want to say that to meet the needs of the community and deeply about the quality of their work and the our medical staff is phenomenal. Before develop new services, because without an patient experience. It’s my job to see that we coming to Cayuga Medical Center I worked eye toward sound financial management our support their efforts in every way we can. as a consultant in health care for many work would be unsustainable. And finally, One of the keys to improving both the quality years and interviewed numerous medical our commitment to community partnerships of care and patient safety is getting timely, staff members at other hospitals. We have is essential because health care is a local honest feedback when staff members pick up physicians coming out of the top medical concern. Our strong community connecon situations that could be unsafe or process- schools in the country. Their training and tions, our involvement on the boards of local es that need to be modified. We are working the high level of care they provide are very organizations—these help to ensure that this to foster an atmosphere in which everyone impressive. medical center is providing access to the is comfortable reporting these observations, Over the years I’ve played a principal role care needed by our community. because this is how we will be able to conwith our physician-hospital organization, tinually improve. Cayuga Area Plan, and with the Cayuga Area Patient safety and clinical quality have There are many standardized measures of Physicians Alliance, which includes most of been the medical center’s top priorities. quality and patient safety in the health-care our medical staff members. I’ve collaborated How will you encourage the continued field. We do very well within the particular with most of the physicians on our medical focus on these issues? set of parameters used by Consumer Reports, staff on various special projects, such as the as reported in their August 2012 issue, which development of our oncology program, the We have an established structure in place identified Cayuga Medical Center as the safest growth of local cardiology services, and our to help us identify safety issues, develop hospital in New York State. However, it was continued expansion in orthopedics, sports processes to resolve these issues, measure clear from that report that we—and every medicine, and athletic training. It’s been our progress, and then cycle back around to other hospital in the country—have signifivery gratifying to work with our doctors in reassess. This improvement cycle is continucant room for improvement and we are workthe design and building of our new imaging al and it’s making a positive difference here. ing hard toward this goal. department, laboratory, and surgical serWe have a very active Quality and Patient vices department. We’re working right now Safety Committee that includes physicians, You’ve worked very closely with the on our new maternity unit, which will open staff, and members of our board of directors; medical staff during the past seventeen in about a year. our board is very focused on quality care years. How would you characterize the Cayuga Medical Center has a mixed and patient safety, which is wonderful. relationship between the medical staff model in terms of our formal relationships I know from my own experience here and the hospital? with area physicians. Some members of our 2 WINTER 2013 / Health Visions Rudd has played an integral role in expanding imaging services to meet the needs of the community. In the Imaging Services Department he chats with Mike Fell, RT (R) CT, and Mike Reynolds, RT (R) CT, who are both radiologic technologists certified in CT scanning. medical staff are employed by the medical center and some physicians are affiliated with the medical center through Cayuga Medical Associates. However, the majority of physicians on our medical staff are still in independent practices, and we work hard to support them because they are essential as we move forward with our strategic initiatives. I think this model is a healthy mix. My own relationships with individual doctors have been established over the years through formal mechanisms, including special projects and many committees including our Physician Council, as well as through informal channels, such as cycling, school sports, and family activities. I value all of these relationships and look forward to making them even stronger. Please describe your personal philosophy of leadership. I believe good leadership is about listening to and serving our employees and physicians in order to help them to do the best job they can. If we are going to promote an environment in which clinical quality and patient safety are openly discussed, analyzed, and improved, I need to hear from employees and physicians about the tools and support they need to do their jobs. My role as a leader is to serve our caregivers and enable them to be excellent clinicians and patient advocates. I also want to hear from the community we serve. I want as much feedback as possible on our patients’ experiences and how the community believes we can improve in providing these services. care-delivery network with accepted, shared standards for measuring our success. This will help us simultaneously address both the quality and the cost of care. Health care reform is upon us because the system as we know it is unsustainable. Please talk about Cayuga Medical Center’s proactive response to this sea change. With a workforce of 1,300 employees, Cayuga Medical Center is the fourth largest employer in Tompkins County. As the heart of the local health-care network, we have a responsibility to provide comprehensive, high-quality care and to meet the health-care needs of area businesses’ employees. Over the years we have teamed up with employers to address acute care needs as well as prevention and healthy living initiatives, such as tobacco cessation programs and stress management classes through the Cayuga Center for Healthy Living. Our shared goal is to create a healthier community. We must go beyond health care in our local relationships, however. The medical center has an additional commitment to work collaboratively on important community initiatives with other employers and human service organizations. One of the We have been working on clinical integration in partnership with our physicians for the past three years. There is a very good article in this issue of Health Visions that explains in more depth what clinical integration is and why it’s so important. Our goal, as we move into the future, is to deliver the best possible health care for patients in our community and to provide this care in the most costefficient way we can. Clinical integration is a very sound way to improve the quality and cost efficiency of the care we provide in partnership with our physicians while preserving our vibrant local health-care network. By working together, the medical center and physicians are developing a stronger How do you see Cayuga Medical Center’s role as a major employer and community leader? www.cayugamed.org 3 The morning meeting in the Intensive Coronary Care Unit with Carrie Westlake, RRT; James Morton, RRT; John Rudd; Dr. Peter Hannon, ICCU medical director; Shawn Newvine, RN, ICCU director; Christine Monacelli, RN; and hospital chaplain Tim Dean. areas in which we are especially interested is protecting our environment. I earned my B.S. degree in biology with a special focus in environmental science, so this particular topic is near and dear to my heart. I was an early member of the Tompkins County Climate Protection Initiative, joining forces with representatives from all of the major local employers. We want to support a sustainable community here, which means that we engage in environmentally responsible business practices, including how we construct new buildings and how we use, reuse, and recycle key resources. I also firmly believe that we, as community leaders, need to give back to our community. One way of doing this is through service on local boards. The list of service by Cayuga Medical Center employees is quite impressive. Over the years I personally have served on the boards of a number of organizations, including the United Way of Tompkins County, Challenge Industries, Kendal at Ithaca, Beechtree Care Center, Franziska Racker Centers, Tompkins County Area Development (TCAD), Opportunities, Alternatives, and Resources of Tompkins County (OAR), and the Tompkins County Chamber of Commerce. 4 WINTER 2013 / Health Visions Cayuga Medical Center has recently expanded services into Schuyler County. Talk about your progress and your plans for the future. Affiliations with world-class health-care providers have provided easy local access to advanced care in cardiology and oncology. How are these affiliations working? Cayuga Medical Center tries to meet regional health-care needs across our service area, which stretches from Cortland to Montour Falls and Watkins Glen, south toward Elmira and Binghamton, and north toward Geneva and Auburn. Over the past couple of years we have formalized our relationship with Schuyler Hospital and developed a collaborative partnership with them. Together we are identifying ways to make sure that care that can be provided in their community is being provided there. To that end, we established Cayuga Schuyler Orthopedic Services to bring state-of-the-art orthopedic and sports medicine care to that community. We are continuing to assess this relationship, which is proving to be very positive. I believe a natural connection and a cultural affinity exist between Tompkins County and Schuyler County that make it easy for us to work together. It’s also a beautiful and easy drive to Watkins Glen—I highly recommend it! Our relationships with those institutions have benefited our community dramatically by allowing us to provide an advanced level of care that would have been impossible otherwise. Eight years ago we were able to launch a very sophisticated radiation oncology program here, thanks to our relationship with Roswell Park Cancer Institute. Opening one of the first stand-alone cardiac catheterization programs here twelve years ago and then transitioning to interventional cardiac care was only possible with the assistance of a world-class provider like the Rochester Heart Institute. Our laboratory is expanding local capabilities through our affiliation with Mayo Medical Laboratories. I believe we can build on these important relationships and continue to develop new local services right here in our community with the help of these organizations. Most recently we entered a collaborative relationship in orthopedics with University of Rochester—Strong Memorial Hospital, which supports our expanding local Orthopedics and Sports Medicine Program. All of our Jim Durkee, executive chef in the Department of Nutrition and Dining, has played a significant role in developing the tasty, healthy menu choices at Cayuga Medical Center. collaborative partners are organizations that support the mission of local health care; however, when our patients need something we don’t provide locally we can expect a very smooth transition of care to a higher level through our established connections. My goal is to see that our community has access to world-class care through Cayuga Medical Center and its affiliate partners. In addition to clinical affiliations we have important academic affiliations. How do these benefit the community? Better medicine is all about raising the bar, and this is accomplished through education. Our affiliations with Cornell University, Ithaca College, Tompkins Cortland Community College, and others have served to raise the bar for us. We get wonderful feedback from doctors in training who have been through the Weill Cornell Medical College teaching rotation at Cayuga Medical Center. These physicians in training spend time at the medical center but also with our community physicians, where they get a more “real world” view of care in a community setting. These positive experiences during medical school and residency would not be possible without the incredible commitment and support of so many of our physicians. This program also helps our physician recruitment efforts as our reputation becomes more widely touted at places like Weill Cornell Medical School. Another great example of raising the bar through an academic affiliation is in our Department of Physical Therapy. Our relationship with Ithaca College and our orthopedic physical therapy residency program are drawing highly trained practitioners to work here because they know we are affiliated with a strong teaching program. As we continue to develop other academic affiliations and strengthen those we already have, our medical center’s reputation is enhanced. This has a positive impact on the quality of providers who want to join us and ultimately affects the quality of care we provide. Just the other day I read a phenomenal letter from a patient about Colleen Masterson, DPT, who was our first orthopedic physical therapy residency graduate and who now works for us. The patient praised Colleen for her clinical skills and for the compassion she showed as a provider. You are personally committed to helping Tompkins County become a healthier community. Please tell us more. Diabetes and obesity are at epidemic levels and predicted to get worse. If we don’t recognize this dangerous trend and strive to make a difference we aren’t doing our jobs as health-care providers. I believe this hospital has an obligation to focus on how we can improve the health of our community, and prevention is a critical part of this. Historically the health-care industry has concentrated far too much on acute care. What we need now is a balanced approach that includes services to promote health and treat the chronically ill, as well as treat acute injury and illness. We are, after all, a health-care organization and that implies taking care of people’s health. This includes helping them to stay healthy and helping them to more effectively manage their health should they become chronically ill. It is through efforts such as the programs offered at the Island Health Center and the Cayuga Center for Healthy Living that I believe we can make a difference. Any final words? In closing I just want to say that I am honored and proud to be a member of the Cayuga Medical Center family. Cayuga Medical Center has been and will continue to be an important part of my life. I am committed to the extraordinary people who work here and to the community we all serve, as we, in partnership, strive to provide the highest quality of care for our community. I am looking forward to the next part of our journey together. Cayuga Medical Center at Ithaca www.cayugamed.org 5 Born to Run! Lithesome and blue-eyed with a ponytail that swings wildly as she runs, Lizzy Jewiss is a driven young athlete. In seventh grade she decided to take up running to stay in shape for soccer. Marathon Track Star Lizzy Jewiss W hen the track coach saw Lizzy working out, he approached her about going out for the track team. As an eighthgrader she joined Marathon’s varsity cross-country team and made it to the New York State Championships. Jewiss, now a senior, has competed in the state finals every year since eighth grade and has been ranked in the top ten in cross-country for class D schools in New York State. In February 2011, when Jewiss was at the peak of her training, she decided to maximize her performance over the next few months. “I wanted to prepare for outdoor track in my junior year,” she says. “I wanted to hit all of the record times.” Her coach and Marathon High School athletics director, Todd James, suggested that she make an appointment with Dr. Andrew Getzin at the Endurance Sports Performance Lab at Cayuga Medical Center Sports Medicine and Athletic Performance. As it turned out Jewiss and Getzin were old friends. She had seen him for a number of injuries over the years, among them a broken wrist from slipping on the gym floor, pulled abdominal muscles from a game of floor hockey, and tendon separation in her foot from a nasty encounter with a recliner chair. Most of these injuries occurred just weeks before major track meets but with Getzin’s help this determined runner inevitably bounced back in time to compete. Jewiss followed her coach’s suggestion and went to the Endurance Sports Performance Lab. She subsequently went on to break all of the women’s indoor track records at Marathon High School for distances from 400 to 3,000 meters. Getting the data While Jewiss ran on the treadmill, Getzin and his colleagues collected data on her heart rate and oxygen uptake levels during VO2-max (maximal oxygen uptake) testing. When used properly this information provides excellent parameters for fitness and is helpful for endurance athletes who want to improve their performance. Jewiss’s treadmill test provided some interesting findings. A training regimen for someone like Jewiss involves a rotating schedule of days designated for easy runs, long-distance runs, and short runs. “I learned that on the days I was doing my easy runs, I was running way too fast,” says Jewiss. “So Dr. Getzin told me to wear a heart monitor during training to guide the intensity and pace of my running. By slowing down during my easy runs I was able to work harder on the days I had my hard, fast runs because I had less recovery from the day before.” “Lizzy learned that you can still make positive gains on days when you aren’t putting extreme stress on your body,” Getzin observes. “You have to get enough rest to be able to run hard when you want to run hard. This is a training mistake a lot of athletes make.” Getzin recently had the seventeen-year-old Marathon High School senior running on the treadmill in the performance lab. Jewiss is currently recovering from a stress fracture in her leg that occurred during the 2012 outdoor track season. “I ignored the injury because I didn’t want to stop running,” she confesses with a guilty smile. “When I finally took care of it I was out for three weeks, so I water trained. I want Dr. Getzin to retest me this coming spring to get a better sense of my fitness and how well I’ve recovered from the stress fracture.” “The challenge in training,” Getzin explains, Dr. Andrew Getzin and Lizzy Jewiss in the Endurance Sports Performance Lab “is that you walk a tightrope between training and over-training. For an athlete the goal is to increase your training stress to a sufficient level that will allow your body to successfully adapt to the new load without injury. In the performance lab we help athletes maximize their performance by providing them with good data to improve their outcomes. Lizzy Jewiss is wonderful to work with,” he adds. “She is a high-level, highly motivated athlete. She’s also had excellent coaching.” Dr. Andrew Getzin, who played football during college and then rugby, is a competitive athlete, earning All-American status with the USA Triathlon for the past four years. In October 2012, he competed in the Ironman World Championship in Kona, Hawaii, having qualified at the Lake Placid Ironman. Dr. Getzin is the clinical director of Cayuga Medical Center Sports Medicine and Athletic Performance and is codirector of the annual Cayuga Lake “One of the things that’s most helpful about Dr. Getzin is that he’s an athlete and he understands that getting back to running quickly is very important to me,” says Jewiss. She remembers when she broke her wrist there were concerns raised that maybe she shouldn’t run until it was healed. “But when I saw Dr. Getzin, he said I could run with my wrist in a cast; I just had to be cautious not to fall and reinjure myself. He understood that I needed to run!” Indeed, it seems running is what Lizzy Jewiss was born to do. Cayuga Medical Center at Ithaca Triathlon Sports Medicine Conference. He is the head team physician for Ithaca College, TC3, and Finger Lakes Gymnastics Academy and regularly provides medical coverage for national sporting events, most recently at the NYC Ironman. For more information on the Endurance Sports Performance Lab visit the Cayuga Medical Center Web site or call (607) 252-3580. www.cayugamed.org 7 A Tale of T Two Thumbs he hand is a complex structure with eight bones in the wrist, five bones that form the palm, twelve bones in the fingers, and two bones in the thumb. These bones, some of which are pretty tiny, are the framework for a complicated network of fascia, joints, muscles, tendons, ligaments, and nerves, all of which are covered in highly sensitive skin. If you stop to consider the range of movement and strength in your handsВ—and the nearly infinite number of tasks for which they are so exquisitely designed—it’s truly amazing. And yet many of us take our hands for granted. 8 WINTER 2013 / Health Visions N ancy Eischen is a labor arbitrator and mediator who started her career at age forty, after raising three sons and then earning a master’s degree from Cornell University’s ILR School. Like all of us she inherited many traits from her parents, among them beautiful silver hair from her dad and osteoarthritis from her mom. Now, at age sixtyone, Eischen says her only health complaint is osteoarthritis. She had carpal tunnel surgery in both of her wrists thirty years ago and now her knees are giving her trouble. Nevertheless, she leads a very busy life with her husband, Dana (a nationally known labor arbitrator), three black Labs, and a twelve-week-old bloodhound puppy named Winston. For well over a decade Eischen suffered from severe osteoarthritis in the basal joints of her thumbs. This small joint at the base of the thumb and adjacent to the wrist enables human beings to grip and grasp. In people like Eischen with advanced osteoarthritis, the cartilage between the bones in the affected joints wears away and, without this cushion, the bones grind together. Eischen describes the sensation in her thumbs as a combination of constant aching and razorsharp pain that radiated up into her neck. “I would lean over to pick up something and my eyes would fill involuntarily because it hurt so much,” she says. “My right hand was especially frightening because at times it was so numb I’d drop things and not even feel my hand letting go.” It became impossible for her to hold her grandchildren safely. “What really makes my story interesting is that I had hand surgery on each of my thumbs, nine years apart, and I got two different results,” says Eischen. “After my first surgery I didn’t do what I should have done. I didn’t do the exercises I was told to do by my surgeon and my physical therapist, and I didn’t take my pain pills. I was lazy. As a result I am still not able to grasp very well with my right hand.” In May 2012, Eischen decided the time had come to have surgery on her other hand. She went into the process with a completely different attitude. “I realized I didn’t do it right the first time around. I went back to Dr. Stephanie Roach, who is a very talented hand surgeon and a lovely person,” says Eischen. “I have a great deal of respect for her and can’t say enough good things about her. She was very honest with me about the fact that recovery from hand surgery is painful but if I did what was required of me, I would get the result she said I would get.” Eischen underwent arthroplasty to remove part of the bone at the base of her thumb. Dr. Roach used the adjacent tendon in the forearm to rebuild a ligament for the joint and fill the joint space with soft tissue. This surgery effectively eliminated pain from the bone-on-bone grinding and with time it would restore movement in Eischen’s thumb. A few days later, Eischen went for the first of her postoperative physical therapy sessions with certified hand therapist Jeff Humphrey, MPT. He fitted her with a custom-made brace and they began physical therapy. “Jeff has a professional, laid-back manner and a quiet, calm demeanor,” says Eischen. “He and Dr. Roach made me want to do the work.” Eischen underwent physical therapy at Cayuga Medical Center’s Brentwood office, which is adjacent to the Convenient Care Campus. “I looked forward to seeing them. Everyone there is very competent and professional. “I did what Jeff told me to do. I did my exercises at home and took my pain medications and I have 100 percent recovery,” says Eischen. “My hands do get tired—between the computer and cooking, I overdo it,” she adds. “But I have no qualms about picking up my beautiful six-month-old grandchild. “It’s a miracle surgery,” Eischen says. “If you want to get the best hand surgery available in central New York and top-notch professional physical therapy, go to Cayuga Medical Center. I’ve had three kids play football so I’ve seen a lot of broken bones and been to a lot of orthopedic surgeons. This is the place to go. The demeanor and professionalism of Dr. Roach and Cayuga Medical Center really worked for me.” www.cayugamed.org 9 Local Hand Care Two Thumbs Up! “We can fix these problems!” Dr. Stephanie Roach completed her fellowship training in hand surgery in 1999 but she has loved this subspecialty since early in her orthopedic residency. “I am fascinated by the anatomy of the hand,” she says. “Most orthopedic residents don’t like hand surgery but I actually didn’t mind being called out in the middle of the night to take care of a patient with a hand injury. These days I’m doing a lot of this type of surgery; I enjoy it and it really helps people.” Given the intricacy and range of motion of the hand and wrist—and how hard they work day in and day out—there is a long list of operations hand surgeons perform on a regular basis. “I do a lot of surgery for carpal tunnel release, trigger finger release, and finger fractures,” says Roach. “I treat a lot of arthritis, especially in the thumb, and I also do joint replacement in the fingers to treat both osteoarthritis and rheumatoid arthri- tis. Wrist fractures often require surgery,” she adds. “These can be tough because they’re so variable and the breaks come in a lot of different patterns. Patients with wrist fractures often need physical therapy after surgery and casting. “Our hand physical therapists are very important for specific problems,” Roach continues. “We couldn’t do tendon repairs without them. They create braces that protect the repair while it’s healing and then they help the patient regain movement after the healing is completed.” Patients undergoing joint reconstruction for thumb arthritis have similar needs. Finger fractures and wrist fractures typically leave people with stiff joints, weakness, and limited range of motion. “Our hand therapists are very knowledgeable,” says Roach. “I get really good feedback from my patients on their care.” If you have a hand problem, Dr. Stephanie Roach would rather see you sooner than later. “Lots of people ignore hand problems for a long time,” she says, “but it’s really worthwhile getting it checked out. If you’ve got troubling symptoms, like tingling, numbness, or pain in your hands and fingers you might have a pinched nerve in your wrist. You want it looked into before permanent damage occurs. We can fix these problems!” Th e H a n d y W o r k o f H a n d Th e r a p i s t s Due to the hand’s intricate anatomy, hand care is a recognized subspecialty among both orthopedic surgeons and physical therapists. Comprehensive hand care is provided locally by two highly skilled orthopedic surgeons with fellowship training in hands and upper extremities, as well as by two experienced physical therapists who are board certified in hand therapy. Jeff Humphrey, PT, MPT, CHT, CEAS, is the physical therapy supervisor at the Brentwood office of Cayuga Medical Center’s Department of Physical Therapy. He has been treating patients with hand injuries for many years, having become a certified hand therapist in 2004. “People sometimes feel Jeff Humphrey, PT, MPT, CHT, CEAS 10 WINTER 2013 / Health Visions that their hands are less important than their feet or legs because they don’t need their hands to walk around,” says Humphrey. “But if you’ve ever injured your hands, you quickly understand that you use them for everything you do all day long— from bathing, dressing, and eating to work activities, hobbies, and sports. Your hands are very important tools.” Humphrey is one of two board-certified hand therapists on staff. His colleague, Mark Malys, PT, CHT, sees patients in the Department of Physical Therapy at the Island Health Center. A third physical therapist at Cayuga Medical Center, Christine Feely, PT, MPT, is in the process of pursuing hand therapy certification. As certified hand therapists, Humphrey and Malys help people recover the function in their hands, wrists, and elbows following traumatic injuries such as broken fingers, wrists, and elbows, burns, and the loss of fingers. They also see many patients with overuse injuries, such as tendonitis and carpal tunnel syndrome, and chronic conditions such as arthritis. Many of their patients require only physical therapy to recover from their injuries and regain function in their hands and wrists. Other patients have had hand surgery and are referred by their hand surgeon for postsurgical physical therapy. Malys, who has been certified in hand therapy since 1996, explains that the position of the hand, fingers, and thumb is crucial following surgery because contractures can occur that make it difficult to achieve full range of motion again. One of the jobs of a hand therapist is to fabricate custom-made splints for postoperative patients to protect the surgical site. This is meticulous work and requires a solid knowledge of the hand’s anatomy, as well as the Stephanie Roach, MD Orthopedic Services of Cayuga Medical Associates 1301 Trumansburg Road, Suite R Ithaca, NY 14850 | (607) 272-7000 Medical School: State University of New York (SUNY) Upstate Medical University (Syracuse, NY) Internship and Residency: SUNY Upstate University Hospital (Syracuse, NY) – Orthopedic Surgery Fellowship: Allegheny General Hospital (Pittsburgh, PA) – Hand and Upper Extremity Board Certification: Hand Surgery; Orthopedic Surgery Honors: Doctor of Medicine cum Laude; Alpha Omega Alpha Medical Honor Society; Phi Beta Kappa Honor Society Areas of special interest: Carpal tunnel release; trigger finger release; finger fractures; joint replacement/finger and thumb; wrist fractures Kim Carney Young, MD Orthopedic Services of Cayuga Medical Associates 1301 Trumansburg Road, Suite R Ithaca, NY 14850 | (607) 272-7000 Mark Malys, PT, CHT patient’s specific surgical procedure. Postsurgical rehabilitation involves controlled, safe movements of the hand while it heals. Collagen is the body’s natural glue, Malys explains, and it is produced during the healing process, forming scars. “Physical therapy is so crucial following hand surgery because the tendons, ligaments, and nerves in the hand are small and prone to developing scar tissue and adhesions, which limit range of motion,” he says. “We can remodel the scar tissue by moving the hand in a controlled way, gently gliding the tendons within the hand to prevent stiffness. Patients are often nervous and in pain and may not want to move their hands at all,” he adds, “so we devote a lot of time to patient education to help them overcome their fears. “We have a good rapport with our hand doctors,” Malys continues. “They send us detailed referrals explaining what procedure was performed and what direction we should take with that particular patient. Through our electronic medical records system we can access the operative reports and read the surgeon’s notes, which often saves us a phone call. But if we have any particular concerns or questions, Dr. Carney Young and Dr. Roach are always willing to discuss them over the phone. “The therapeutic process for hand surgery is a triad,” Malys concludes. “You need a good hand surgeon, a good hand therapist, and a patient who is committed to doing the work it takes to heal well.” Cayuga Medical Center at Ithaca Medical School: University of Buffalo School of Medicine (Buffalo, NY) Internship and Residency: University of Rochester Medical Center (Rochester, NY) – Orthopedic Surgery Fellowship: Hospital for Special Surgery (New York, NY) – Hand and Upper Extremity Board Certification: Orthopedic Surgery Honors: New York Society for Surgery of the Hand (NYSSH) 2nd Place Research Symposium; “Strong Star” patient-nominated award for excellent patient care; Alpha Omega Alpha Medical Honor Society; Dean’s Letter of Commendation throughout medical school; American Society for Surgery of the Hand (ASSH) Young Leader 2011; ASSH Information Technology Advisory Group committee member Areas of special interest: Joint replacement/ finger, thumb, wrist, and elbow; wrist arthroscopy; post-traumatic reconstruction of hand and wrist; treatment of complex trauma www.cayugamed.org 11 Fighting Back Aga i n s t H e a r t At tac k It’s not hard to pick out Shawn Bell in the monitored cardiac exercise class at the Island Health Center: he’s the thirty-nine-year-old guy in a baseball cap. Fit and young, the father of two sons, six and eight years old, Bell is not a person who comes to mind when most of us think about people who have had heart attacks. A pril 20, 2012, had been a fun day romping outside with the kids and riding four-wheelers around their home in Venice, a small town west of Moravia. The Bells and visiting friends ordered take-out Chinese food and the evening wound down watching a movie on TV. Andrea Bell, a cardiac nurse at Cayuga Medical Center, turned in at 10:00 p.m. because she was on emergency call that weekend for the Cayuga Heart Institute. Around 10:30 Shawn began to feel very strange. “I was uncomfortable and I stood up, sweating,” he recalls. “Then it felt like I had about forty knives in my chest. I was thinking I had indigestion from the take-out food.” He walked into the bedroom and crumpled to his knees at the edge of the bed. “Andi [his wife] asked me what was wrong and flipped on the light, and meanwhile I’m thinking I really need some Rolaids!” “Initially I thought he had a stomach bug, but as soon as he clutched his chest my first instinct was to call 9-1-1,” says Andrea. “We went into the bathroom because Shawn felt nauseous; he started to pass out and I called his name. I dug an aspirin out of our first aid kit under the sink (it wasn’t in the medicine cabinet because we use ibuprofen in our house) and had him chew it. I don’t know if I knew at that point that he was having a heart attack—I was in disbelief—but my training automatically kicked in and I knew what to do. Then we walked out on to the porch to get cooler and wait for the ambulance. Shawn turned to me and said, вЂ�Take care of the boys,’ ” she remembers, tearing up. Long Hill Fire Department arrived first, within a few minutes of Andrea’s call, and Southern Cayuga Ambulance arrived quickly thereafter. The crew put Shawn on a stretcher and told Andrea they would meet her at a nearby hospital. She said, “No, I’ll see you in Ithaca; I want you to take him to Cayuga Medical Center.” The ambulance EMTs (emergency medical technicians) confirmed that Shawn was having a heart attack. “It was really, really terrifying,” says Shawn. “It’s the worst pain I have ever experienced. I’ve had two knee surgeries and busted fingers, but this was by far the worst pain I’ve ever felt. I was also thinking about my family history,” he adds. “Not many men on my father’s side lived to see sixty-five because they all had heart issues. There’s a history of heart disease on my mother’s side, too.” When seconds count When EMTs respond to a 9-1-1 call for a suspected heart attack, they perform an electrocardiogram (EKG) right on the spot. When a patient is suffering a major heart attack in which the coronary artery is completely blocked, the EKG reading shows certain characteristic changes. This change is called ST segment elevation. Among cardiac care providers this is referred to as a STEMI heart attack. STEMI is an acronym for ST segment elevated myocardial infarction and it is serious business. The Southern Cayuga Ambulance crew contacted the Emergency Department from the road and a call immediately went out to the Cayuga Heart Institute STEMI Team, which is a specially trained group comprising an interventional cardiologist, cardiac care nurses, and technicians. The STEMI Team is on call 24/7. Before Andrea Bell drove to the Emergency Department that night, she called her supervisor, Sharey Selover, RN, to tell her she was on the way to the hospital and needed someone to cover on-call for her. Right after Andrea hung up, she received a call on her cell phone summoning the STEMI team to the Cayuga Heart Institute to take care of an incoming heart attack patient. She knew that patient was Shawn. Interventional cardiologist Dr. Stephanie Goodwin arrived at the Emergency Department within minutes of Shawn’s ambulance. “STEMI heart attacks are the type of heart attack we have talked about a lot in our community education programs,” says Goodwin. “These are critical situations where we have to open up the artery as quickly as possible. It turned out that Shawn’s right coronary artery was 100 percent blocked. Another artery was 80 percent blocked and a third was 50 percent blocked.” Goodwin introduced herself to Shawn and started to explain www.cayugamed.org 13 about opening his blocked artery with balloon angioplasty and a stent, but he told her he knew about it already because his wife worked in the cardiac cath lab. Goodwin turned around to see her colleague, Andrea Bell, peering into the room. “It’s tougher to take care of the spouse of someone you know, especially a young father with kids,” Goodwin admits. “Kids really need their fathers.” Shawn was whisked up so I didn’t think twice about where I wanted Shawn to go. I knew if he had a problem they could fix, they would fix it. And if they couldn’t fix it, they would stabilize him quickly and safely. We are all held to a very high standard here and I’m very confident in this team. “Shawn did get special treatment,” says Andrea. “He got exactly the same special treatment all of our patients get. I work “Shawn did get special treatment. He got exactly the same special treatment all of our patients get.” Andrea Bell, RN to the cardiac catheterization suite where the team was already assembled, thanks to the timely call from Southern Cayuga Ambulance. Sandra Fuller, RN, director of the Cayuga Heart Institute, had come in on a moment’s notice to take over Andrea’s on-call shift. on the STEMI Team. We take care of the patient and the family—and they did for me exactly what I’ve done for others. We move very quickly here and it was kind of surreal watching it all happen from another perspective. Shawn’s care was just as fast and efficient as the care here always is.” Special treatment Time is muscle! Andrea Bell paced about the waiting room at the Cayuga Heart Institute while the team worked on her husband. “As soon as the on-call team was here and Dr. Goodwin got Shawn into the cath lab, I breathed a sigh of relief,” says Andrea. “I knew he’d be okay at that point.” When asked about her decision to take Shawn to Cayuga Medical Center instead of a hospital that was closer, Andrea is very clear about her rationale. “I didn’t know if there was interventional care [at the other hospital] but it wouldn’t have made a difference in my decision. I’ve worked closely with the team here. The whole staff at the Cayuga Heart Institute is amazing, 14 WINTER 2013 / Health Visions Cardiac care guidelines call for hospitals to open a blocked coronary artery (using catheters and devices such as balloon angioplasty and stents) within ninety minutes. This window of time is called door-toballoon time. Shawn’s door-to balloon time was thirty-five minutes, which means that his blocked artery was open and life-saving blood was flowing into his heart muscle just thirty-five minutes after he came through the Emergency Department doors. “When we looked at his heart function the following day, it was near normal,” says Goodwin. “This implies that there was not substantial damage to his heart, which is our goal.” On May 10, Shawn went back to the Cayuga Heart Institute so Dr. Goodwin could perform stenting on the heart artery with an 80 percent blockage. On June 1, he returned to his job as an engineering technician at Cargill Deicing Technologies. Two weeks later he started eighteen weeks of cardiac rehabilitation with the Cayuga Center for Healthy Living at the Island Health Center. A new normal The cardiac rehab program offered Shawn five classes and he took all of them, covering topics such as diet, stress relief and management, medications, exercise, and the impact of family history on heart disease. “I wanted to learn everything I could to prevent this from happening again,” says Shawn, “and I recommend that anyone with similar issues take advantage of these classes. I learned how to exercise properly in cardiac rehabilitation, where my heart is monitored. It’s been an eye-opening experience for me.” “Everything has changed in our house,” says Andrea. “Our diet wasn’t horrible before but we have completely changed how we eat. Now we eat two fish meals a week and much more vegetarian food. This change is family-wide. Shawn is also on five medications a day. Our kids ask at mealtime if Daddy has taken his medicine.” “Right after I got the first stent I felt about ten years younger,” says Shawn. “I feel excellent. I have more energy and can do much more now without being winded. I just didn’t realize how bad I had been feeling; I wasn’t listening to what my body was telling me. You know, when we think of heart problems, we tend to think of older people, who are overweight and who smoke,” he adds. “But I’m a young, healthy, active person. If this could happen to me, it could happen to anyone.” What you should know about “The interventional services at the Cayuga Heart Institute are benefiting many people in the community—from people in their twenties to those in their nineties.” Stephanie Goodwin, DO, FACC heart–attack symptoms u Symptoms can occur in the center of the chest from the bottom of the ribs to the neck, and may also involve the throat, arms, jaw, and back between the shoulder blades. u Symptoms can vary. Some people experience a sensation of pressure, burning (similar to indigestion), an ache, or a feeling of tightness. They often describe their symptoms as discomfort, rather than severe pain. Other people, like Shawn Bell, experience crushing chest pain. u The symptoms may be constant but can also fluctuate in intensity. u Symptoms may be accompanied by shortness of breath, nausea, vomiting, sweating, light-headed- ness or passing out. Dr. Stephanie Goodwin, Cayuga Heart Institute at Cayuga Medical Center Life-saving information “There is no question that Andrea saved Shawn’s life,” says Dr. Goodwin. “It’s very important for people to understand that her actions to get him to the hospital so quickly saved him. And everything Shawn has done to change his life subsequent to learning he has heart disease will realize long-term benefits for him. He’s been a great patient in terms of recognizing the importance of risk modification and participating in cardiac rehab. Risk factors can include smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of physical activity, and family history. His health now is excellent.” According to Goodwin, while heart attacks in people aged forty and younger are not common, they do happen more often than most people believe. “The vast majority of cardiac patients we’ve managed here in the urgent or emergency setting have been on the younger side, under seventy-five years old,” she says. “The interventional services at the Cayuga Heart Institute are benefiting many people in the community—from people in their twenties to those in their nineties—and have made a substantial difference in improving survival rates and overall heart health.” What’s the take-away message? Know the signs of heart attack. And even if you are not certain the symptoms you are having are those of a heart attack, call an ambulance anyway. “I thought my care was awesome: I had the best of everything. I couldn’t have asked for a better hospital stay,” says Shawn Bell. “If it weren’t for Andi, Dr. Goodwin, the STEMI Team, and all of the staff who took care of me, I wouldn’t be here,” he adds. “Words cannot describe how I feel.” If you or someone you are with experiences these symptoms and you are not sure what is wrong, call 9-1-1. Cayuga Medical Center at Ithaca www.cayugamed.org 15 Still Cookin’! 16 WINTER 2013 / Health Visions Still Cookin’! K ristof Ostlund is an Ithaca luminary among people with a penchant for Mexican and southwestern cuisine. He was the chefowner of the enormously popular restaurant Coyote Loco from 1991 to 2003, and over the past twenty-four years the breakfast burritos from Solaz, his popular vendor stand at the Ithaca O stlund’s painful journey began in July 2008, right after the Grass Roots Festival where for seventeen years his booth has drawn long lines of hungry festival-goers. A makeshift ramp at the back of his pickup truck didn’t hold and he landed hard on his left foot, twisting it and badly breaking both bones in his lower leg just above the ankle. Orthopedic surgeon Dr. Stephanie Roach surgically repaired the breaks with a six-inch plate on the outside bone (the fibula) and two long screws in the inner bone (the tibia). Ostlund, who was also cooking for a Cornell sorority at the time, got around on a turning leg caddy, which is a fancy scooter designed to keep his weight off the lower part of his injured leg. However, three months later an X-ray revealed there was insufficient bone growth to heal the break in the fibula. He switched to a walking boot cast, and for the next forty days he used a magnetic bone-growth stimulator. Ostlund says it was a long, hard haul. The bones eventually knit together but the muscles in his leg had atrophied. Physical therapy, along with weight training at Island Health and Fitness, helped strengthen his muscles, but even with special support hose his lower leg and foot remained very swollen. This condition, called lymphedema, can develop following a traumatic injury when lymph fluid cannot flow freely though the affected limb due to scar tissue. Seven months after the initial breaks, Ostlund went to see Dr. Guillermo Ferrer, who is a board-certified general surgeon with fellowship training in vascular and thoracic surgery. Ferrer specializes in treating lymphedema and vein disorders, including venous stasis Farmers Market, have become legendary. At 6’5”, Ostlund towers over his Solaz helpers at the Saturday market. These days his regular customers are happy to spot his lanky frame standing up at the grill once again after four long years of having to cook sitting down due to an injury that just wouldn’t heal. ulcers. These painful wounds are caused by venous hypertension, a condition in which blood flow in the legs is impaired. “Dr. Ferrer explained the problems I was having with my circulation and my lymph system and the possibility of complications should I develop an infection,” says Ostlund. “He gave me a pneumatic boot to wear to increase the circulation in my left leg. I used it for about six months.” One morning, eighteen months after the accident, Ostlund noticed a tiny scab on the outside of his foot. “I didn’t remember cutting my foot so I couldn’t figure out where that little scab came from,” Ostlund recalls. A visit to his primary care physician, Dr. Lloyd Darlow, provided the answer: that tiny spot was the onset of an ulcer and proved to be the beginning of a whole new set of very difficult problems. When time doesn’t heal all wounds In the body’s circulatory system, the arteries carry oxygenated blood to the tissues and the veins carry the oxygen-depleted blood back to the heart and lungs. As the blood travels up the leg and back to the heart, a series of little valves in the leg veins open and close to help move the blood upward. A second, very important network of vessels and nodes called the lymph system works in tandem with the circulatory system to fight infection and promote healing. The microscopic lymph vessels carry fluid made up of molecules of protein, water, fats, and waste, along with cells that attack bacteria in the blood. Lymphatic fluid ultimately drains into the central venous circulation. www.cayugamed.org 17 “The wound was not going away, it hurt like crazy, and I was freaking out.” “Kristof was born with venous insufficiency, Dr. Guillermo Ferrer Tammy Molitis, LPN, and Dr. Cora Foster, director of the Cayuga Center for Wound Healing with the hyperbaric chamber. 18 WINTER 2013 / Health Visions which is the inadequate return of blood to the heart from peripheral veins in the legs and arms, usually due to an inefficient venous valvular system,” Ferrer explains. ”This underlying condition made it difficult for him to heal following the trauma to his leg. As a result, the tissue became more and more fragile, which contributed to the breakdown of his skin and the creation of ulcers. “The soft tissue damage at the level of the ankle compounded his problem,” Ferrer continues. “We have lymph nodes stationed throughout the body, especially at the joints. The ankle is narrow so trauma there can produce chronic swelling, or lymphedema, and this makes the tissue prone to infection. It is a vicious cycle.” In 2010 Ostlund’s ulcer began to grow due to the compromised blood circulation in the veins of his leg, and he was referred to the Cayuga Center for Wound Healing. “The ulcer became the size of a half-dollar coin,” Ostlund remembers. “They put me in a special four-layer compressive wrap and over time the ulcer started to shrink.” Then Ostlund worked a hectic four-day weekend at the Grass Roots Festival. “It was the year of the horizontal rain and I got thoroughly soaked,” he says. “A couple of days into the event I felt an ulcer developing on the other side of my foot. I now had one ulcer that was healing on the outside of my foot and another one that was growing on the inside of my foot. The new ulcer grew to nearly three inches long and three- sixteenths of an inch deep.” The pain intensified and Ostlund developed an infection. Over the course of a year, the ulcer grew worse, then better, and then worse. “Each time the ulcer became infected, the overall tissue damage increased, making the tissue more prone to breakdown and infection to the point where the ulcer would not heal at all,” says Ferrer. “At various periods I was in the wound clinic as often as three times a week,” says Ostlund. “The people taking care of me there were very experienced and the bandaging went smoothly.” But in February 2011, Ostlund developed yet another infection, this time on the bottom of his foot. “My foot became very painful and red,” he recalls. “I called Dr. Ferrer and described my symptoms to him over the phone. He told me to go directly to the Emergency Department at Cayuga Medical Center. I ended up being infused with IV antibiotics twice a day for two weeks. “The wound was not going away, it hurt like crazy, and I was freaking out,” says Ostlund. “The pain made it difficult to get through the day. After cooking all day, I’d sometimes go up to the bedroom, stick a pillow over my head, and just scream. But through it all the doctors and nurses in the wound clinic helped me keep my spirits up.” The impact of oxygen In September 2011 Cayuga Medical Center introduced hyperbaric medicine to Tompkins County. Ostlund’s chronically infected wound made him a candidate for this therapy. “Hyperbaric therapy is based on a relatively simple principle,” Ferrer explains. “If we can provide more oxygen to tissues, they will heal. The patient is not only breathing 100 percent oxygen while in the hyperbaric chamber, but this happens in a pressurized atmosphere. The deeper the pressure, the more oxygen enters the tissue that has been starving for oxygen. It enters the tissue through the lungs and also passes directly into the tissue from the outside, entering every single cell of the body. Hyperoxygenation with intermittent periods of rest allows healing to occur.” Following a new round of antibiotics, Ostlund took his first “dive” in the hyperbaric chamber. “The first time I went into the tank I was really nervous,” says Ostlund. “I was nervous because I was afraid it wouldn’t work or that I wouldn’t be able to do it; I had tried skin diving before and my ears couldn’t take the pressure. But mostly I thought: if I can’t undergo this therapy to heal this wound, what am I going to do? I was scared.” “Kristof is predisposed to this problem so it doesn’t take much for ulcers to develop,” explains Ferrer. “Ulcers can happen spontaneously or develop from a minor specific event, such as a bump, an insect bite, or improperly fitting shoes. We used every approach to help him heal—pneumatic devices, compression bandages, compression stockings— to no avail. We performed a graft of bioengineered skin but this did not work either. Since his tissue had such poor oxygenation, our last available option was to hyperoxygenate the tissue, which we were able to do with the introduction of hyperbaric wound therapy at Cayuga Medical Center.” Over a period of two and a half months, Ostlund had a total of forty-five sessions in the hyperbaric chamber, “It’s wonderful to have this tool available now to heal wounds that in the past could basically be lifelong problems, and it is very important that people know we have this therapy available locally to promote healing.” Guillermo Ferrer, MD ranging from two to five sessions a week in the beginning. Ear, nose, and throat specialist Dr. Rob Strominger put tubes in Ostlund’s ears so he could be comfortable in an environment that was equivalent to 2.5 atmospheres or fiftyfive feet deep under water. Each therapy session took nearly three hours. “Having this service available locally was a huge, huge help,” says Ostlund. “Given how long the sessions take, traveling out of town for this therapy would have meant I’d be out of work until I healed. “I watched the wound get smaller and smaller,” Ostlund continues. “The infection disappeared and I was discharged in January 2012. It took two years to heal this last ulcer; I celebrated two birthdays with my nurses in the wound clinic. They were very, very compassionate,” he adds. “I was hurting and scared and there were times when I was difficult but they never got upset.” “Kristof is now healed, but he is also aware that this problem can recur given his predisposition,” says Ferrer. “I think it’s wonderful to have this tool available now to heal wounds that in the past could basically be lifelong problems, and it is very important that people know we have this therapy available locally to promote healing.” “You have to maintain your sense of humor to keep your sanity,” says Ostlund smiling. “I am finally healed up and back to wearing regular shoes and support hose with heavy compression. I am now fully sympathetic with the plight of women when they have a run in their stockings. And because I cannot afford to break my leg again, they’ll be no more hang-gliding for me!” That’s fine with the many people who appreciate Kristof Ostlund’s cooking. Cayuga Medical Center at Ithaca www.cayugamed.org 19 N av i g at i n g t he Lo ca l sara taylor 20 WINTER 2013 / Health Visions He a lt h - Elyse Putorti, ATC, Patient Navigator - Care System Sara Taylor is a very busy wife and mom, with two young sons ages nine and three. She had been experiencing a slowly progressive knee problem when a Zumba class in March 2012 put the finishing touch on what turned out to be a torn meniscus. A trip to the Urgent Care Center on Arrowwood Drive in Ithaca confirmed the diagnosis, and before she left she had been given the phone number of Cayuga Medical Center’s orthopedic patient navigator. “I called the number and the patient navigator called me back within five minutes,” says Taylor. “She made an appointment for me two days later at Dr. Mannino’s office [Orthopedic Services of Cayuga Medical Associates]. My family and I were going out of town so Dr. Mannino added me to his operating schedule four days later so we could still make the trip. The patient navigator called me the day after surgery to check in and see how I was doing.” After surgery to repair her injured knee Taylor began physical therapy with Margaret Vence, DPT, Cayuga Medical Center’s director of Orthopedics and Sports Medicine. Taylor is concentrating on Pilates and yoga these days to stay in shape and says she is happy she had the surgery. “The patient navigator service is wonderful, convenient, easy, and accommodating,” says Taylor, “especially in comparison to other scheduling experiences I’ve had. And the care I received was excellent— on a scale of one to ten it was definitely a ten!” Help is just a phone call away “Patient navigation is really about helping patients find their way around a complex healthcare system,” explains John Rudd, Cayuga Medical Center president and CEO. “If you are someone with a cancer diagnosis or an orthopedic injury, there are typically several different care providers involved in your treatment. Having someone who can guide you through all the different aspects of care makes for a much more focused and positive patient experience.” Cayuga Medical Center now employs three patient navigators whose jobs are to help patients understand their specific illness or injury and to help them gain easy access to the services they need in a timely fashion. Elyse Putorti, ATC, is a certified athletic trainer and the ortho- pedic patient navigator. She helps patients like Sara Taylor with orthopedic problems and sports-related injuries. Putorti’s athletic training at Ithaca College enables her to ask the right questions over the phone to determine if the patient needs to be seen immediately or whether an appointment within the next twenty-four to forty-eight hours is soon enough. She also oversees the Joint Solutions Program for patients undergoing hip and knee replacement surgery. “My main job is to talk with patients who have orthopedic concerns and questions. The person I am talking to on the phone has my undivided attention,” says Putorti. “Essentially I have two roles,” she continues. “One is to help patients get in to see the appropriate care provider as quickly as possible and to advise patients on self-care until they see the doctor. My other role is to assist primary-care doctors and urgent-care doctors with referrals for patients with orthopedic and sports-related injuries. As the liaison between the patient and the care providers, I help coordinate care for each patient.” Additionally she helps patients understand the referral process to satisfy the requirements of their health insurance policies. Putorti emphasizes that callers will reach her directly unless she is on the phone helping another patient. During the phone call she will ask about your injury and she will not conclude the phone call until you have an appointment with a doctor. You will not be transferred; rather, you will stay on the line together until the appointment is established. “Patient feedback indicates we’re getting great results,” says Putorti. “I monitor our orthopedic, sports medicine, and physical therapy services and I share feedback with the practice managers. Patients who have previously traveled out of town for care tell us they’ve never had this kind of clear explanation and diagnostic help before.” www.cayugamed.org 21 john powell, MD Betty Mc Ever, RN A ho listic approach to ca n ce r car e F Meet John Powell, MD, Radiation Oncologist Dr. John Powell is the newest member of the cancer care team at the Cayuga Cancer Center. He earned his undergraduate degree in biology from Cornell University and went on to medical school at Upstate Medical University in Syracuse, where he was inducted into the Alpha Omega Alpha Medical Honor Society. He completed his radiation oncology residency at Upstate University Hospital. Dr. Powell returns to Ithaca from North Carolina, where he had been a radiation oncologist at Carteret General Hospital in Morehead City. While there he served as chairman of the Cancer Committee and chairman of the Department of Clinical Support, and was a member of the Medical Executive Committee. Navigating C ancer C are C ayuga Medical Center is accredited with commendation as a Community Hospital Comprehensive Cancer Program by the American College of Surgeons’ Commission on Cancer. n Radiation therapy is provided in a state-of-the-art facility located adjacent to the medical center. This service is offered in collaboration with the Roswell Park Cancer Institute. n Patients have access to complete cancer testing and diagnostic services through the close collaboration of Imaging Services, Surgical Services, and Laboratory. n Oncology nurse navigation services help patients and families find their way through diagnosis and treatment with personal attention, education about the specific cancer they have been diagnosed with, and an abundance of information about local support services. n Three board-certified medical oncologists work closely with patients and families to plan cancer treatment based on the latest protocols. 22 WINTER 2013 / Health Visions ew life events elicit the levels of fear and uncertainty that come with a cancer diagnosis. Coupled with this anxiety is a lack of understanding about what the specific diagnosis means, what the treatment choices are (and their likely side effects), and what resources are available to help patients and families through this difficult journey. Betty McEver, RN, BSN, OCN, CRN, brings over thirty years of nursing experience to her job as oncology nurse navigator. Her list of special certifications includes oncology nursing, radiology nursing, and oncology nurse navigation. “Everyone’s story is different, their cancer is different, and their needs are different,” says McEver, whom everyone calls Nurse Betty. “My job is to listen reflectively to patients, to educate them about their illness, and to help them determine their own best options. Then I act as a liaison between each patient and his or her doctors and the various medical center departments involved in their care.” She also helps patients connect with community resources providing assistance with everything from transportation to wigs for hair loss. “The care of each patient is unique to that person,” McEver continues. “This is what we mean when we say вЂ�The Center Is You.’ Our whole focus here is patient-centered care.” Tompkins and the counties that surround it are home to a diverse population and cancer is an equal opportunity illness. “We bring as much cultural awareness as we possibly can to our care,” McEver points out. “We also work with patients with various disabilities and mental health issues. Many patients facing a cancer diagnosis have what we call co-morbidities or co-existing medical conditions, such as diabetes or liver disease. All of these factors influence their individual cancer treatment.” One particular aspect of care McEver spends time educating patients and families about is palliative care. “I want to introduce the concept of it earlier in their care,” she explains. “Palliative care is a multidisciplinary approach to relieve suffering. It’s not just about terminal care—it’s about quality of life.” Many patients who are in the process of curative cancer treatment seek palliative care to help them cope more comfortably with difficult side effects. McEver says she regards people holistically because she is best able to help them that way. “I consider their environment Health and Human Performance “Patient navigation is really about helping patients find their way around a complex health-care system.” john rudd and their health in body, mind, and spirit. Being a nurse is not just about medicine; it’s about promoting health to improve the quality of a person’s life. Sometimes quality of life can be a higher priority than longevity,” she adds. “Although a cancer diagnosis can be the worst thing ever, sometimes a cancer diagnosis can change a person’s life in positive ways. People often quit smoking, learn to manage their stress, and begin to make time for exercise, meditation, and prayer. You can gain a whole new perspective on life. “We hear a lot of positive feedback from patients,” says McEver. “They write and call to thank us for taking the extra time and for making the effort to help them. We’ve had good success in removing barriers to care for patients and that can make all the difference in their treatment and follow-up care.” If you need help navigating your orthopedic care or the complexities of a cancer diagnosis, call one of our patient navigators. They will advocate for you and help you find your way. Cayuga Medical Center at Ithaca Contact information: Elyse Putorti, ATC, orthopedic and sports medicine patient navigator: (607) 252-3510 Betty McEver, RN, BSN, OCN, CRN, oncology nurse navigator: (607) 274-4046 K risten Verrill, PT, has been appointed to the position of director of Health and Human Performance at Cayuga Medical Center. In her new role she will oversee the departments of Physical Therapy, Orthopedics and Sports Medicine, and Athletic Performance, working closely with Margaret Vence, DPT, director of Orthopedics and Sports Medicine, and Brian Lee, PT, OCS, CSCS, director of Physical Therapy. She will continue as director of the Cayuga Center for Healthy Living (CCHL) and will also act as the liaison to both Island Health and Fitness (IH&F) and Rasa Spa, which are collaborative partners with Cayuga Medical Center. “We have such a rich menu of services designed to help people reach their wellness goals, recover from injuries, and establish healthy lifestyles,” says Verrill. “Each person who comes to us for help has unique needs. Our goal is to assist them in living the healthiest lives they can by accessing the services they are looking for. “If you are trying to reduce the stress in your life, you may want to consider taking the stress management class at CCHL, getting regular massage at Rasa Spa, and joining an exercise class at IH&F,” Verrill explains. “Or if you are recovering from an injury, you might want to augment your physical therapy with water aerobics at IH&F in the warm water pool. We also offer classes at CCHL and IH&F to meet the special needs of patients before and after bariatric surgery. People recovering from heart attacks often transition directly from classes in cardiac rehabilitation and tobacco cessation to therapeutic yoga at Rasa Spa and to memberships at IH&F so they can maintain the gains they’ve made in their recovery process.” In the past decade Cayuga Medical Center has introduced many new programs and classes specifically for people who want to become as healthy as they can. “Nowhere else in the region will you find what we are offering all in one building,” says Verrill, referring to the Island Health Center. “This is all part of Cayuga Medical Center’s focus on improving the health of our community. “If you have healthy lifestyle goals for the new year, check out the menu of services at Island Health and Fitness, Rasa Spa, and Cayuga Medical Center—and get in touch,” says Verrill. “We want to be your partners in good health!” Cayuga Medical Center at Ithaca www.cayugamed.org 23 Bringing It All Together through Cl i n i c a l I n t e g r a t i o n a higher price tag for goods and services often means higher quality. This is not always the case, however, when it comes to health care. For more than two decades experts working with the Dartmouth Atlas of Health Care have studied Medicare billing records and discovered huge variations in treatment and spending between communities. Some communities spend three times as much as others with no better results, due to unnecessary tests, procedures, and services. More expensive health care is not necessarily better health care, and it may actually be more inefficient. Sadly, the problem worsens exponentially for the sickest among us. In the last decade alone the cost of employer health insurance premiums and employee contributions to their health-care plans have more than doubled. Local health-care providers have dedicated themselves to reversing this trend in our community. The Cayuga Area Plan (CAP) is a partnership that includes Cayuga Medical Center and the Cayuga Area Physicians Alliance (CAPa), a network of local providers. CAP has been working diligently to craft a system that will improve the quality and efficiency of patient care. Care that is better managed will have the additional value of holding costs in check. The Clinical Integration (CI) Program offered through CAP is now up and running in our community. The primary goals of clinical integration are to improve clinical quality and patient outcomes, improve the care of high-risk patients, and reduce the overall cost of care. Clinical integration is a local health-care system that promotes a high degree of interdependence and cooperation among participating physicians. Using advanced information technology, doctors in a clinically integrated system can efficiently share data on patients and improve the delivery of health care. This cooperation minimizes duplicate diagnostic testing 24 WINTER 2013 / Health Visions and provides an avenue for real-time consultation among members of a patient’s care team. “Interaction between doctors and offices will be smooth and fast and well worth the price of implementation,” says Lloyd Darlow, MD, vice president for clinical integration at Cayuga Medical Center. “We are focusing on the value of the care provided to patients rather than the volume of care,” points out John Rudd, president and CEO of Cayuga Medical Center. “We believe we can improve both quality and efficiency without sacrificing one for the other. What makes our program different,” he adds, ”is that our model includes both hospital-employed and independent physician practices. We believe it is important to work in collaboration with our independent physicians to make improvements.” “This has been a monumental, multiyear undertaking with many interconnected components,” says Darlow. “It has required a significant commitment of time, financial resources, and good will on the part of Improve Physical Health and Fiscal Health The Three Major Functional Components of Clinical Integration 1 2 3 Physician clinical metrics for every medical specialty This means that doctors agree to be assessed on how they manage the care of their patients. They agree on the standards of care by which they will be evaluated, and they receive real-time feedback on how they are doing. Coordination of the care of the sickest patients in our community This is accomplished through a program of care management administered by local doctors and nurses. Local care management is critically important because it provides a higher level of service to the people who need it most, and by helping the sickest among us manage and coordinate their care, it holds costs in check. Development of electronic health records This incorporates electronic medical records and health insurance data to provide a perspective across multiple care providers’ locations. This data is assembled in collaboration with ActiveHealth, a nationally recognized health-care information company. By working with the health insurance statistics of local employers, CAP physicians can review data from all of a particular patient’s care providers to make sure the person is receiving care in a holistic way. www.cayugamed.org 25 Let’s use asthma as an example to illustrate the difference clinical integration can make. scenario #1 A scenario in a system without clinical integration Our hypothetical patient is a fifty-five-year-old woman needs to pay a coworker overtime to cover for her. with asthma. For some reason, her asthma has been growing steadily worse over the past two years. She has specialist, who prescribes a new medication. Without seen her primary care physician, who has prescribed clinical integration, the primary care doctor may not know medication and an inhaler and asked the patient to come about the Emergency Department visits or the hospitaliza- back for a checkup in two months. tion. The asthma specialist and primary care doctor may not be in direct contact with each other to consult on During those two months the patient makes two trips The patient makes an appointment to see an asthma to the Emergency Department in respiratory distress. medication and the best course of treatment. The care is The second trip results in an overnight hospitalization. fragmented, the patient doesn’t feel well, she is missing She has a pulmonary function test that determines her work, and her employer’s health insurance provider is lung function is impaired. paying for care that might have been avoidable in a more integrated system. Over a six-month period she misses several days of work during an especially busy season and her employer scenario #2 The same scenario in a clinically integrated system Because our asthma patient is seeing her doctors caregivers manage her asthma. more frequently than usual and is making multiple trips With more regular care and proactive support, the to the hospital, she is identified as a high-risk patient patient is able to identify when and why she is feeling and is assigned a care manager. The care manager is a worse and works to rectify the situation. She does not ex- nurse who works very closely with the patient and the perience as many acute episodes that require emergency patient’s doctors to help coordinate her care more pro- intervention and hospitalization. The patient, the care actively and effectively. Through frequent conversations manager, and the doctors all work to manage her asthma and e-mails the care manager learns from the patient risk and move her from the high-risk category to the that her son, who is a smoker, has moved back into the moderate- or low-risk category. By receiving a higher patient’s home, bringing a beloved pet with him. This quality of coordinated, integrated care she is healthier is new, critically important information that will help and she is using fewer health care resources. 26 WINTER 2013 / Health Visions Cayuga Medical Center and the members of the Cayuga Area Physicians Alliance, which I am proud to say includes the vast majority of physicians practicing here.” Clinical integration: the good news in health care Martin Stallone, MD, MBA, director of hospitalist medicine at Cayuga Medical Center, serves as the medical director of the CAP Clinical Integration Program. “A television special on PBS entitled вЂ�U.S. Health Care: The Good News in American Medicine’ aired in February 2012. It profiled different communities across the country and talked about the most successful, innovative community health initiatives in the nation,” says Stallone. “We’re doing as much as, if not more than, the communities featured in the special.” Clinical integration is in many ways a simple concept, but its execution requires close collaboration and commitment. “Using the platform of CAP, which has been in place for fifteen years, independent physicians, hospital-employed physicians, and the medical center can come together in an atmosphere of trust and respect. This kind of collaboration just doesn’t happen in most communities,” observes Travis Turner, executive director of CAP. “As the CI Program moves forward, we can provide real value to employers and high-quality health care to the residents of our community.” How does it all work cohesively? “Every time a health insurance card is presented at the doctor’s office, at the hospital, or at the drugstore and a claim is generated, this data flows into our system,” says Darlow. “ActiveHealth collects the claims data and feeds it to our program administrators. We can use it to help improve care while holding costs in check. There are very few clinically integrated systems like this in the country. However, these networks have shown that they have healthier patients and an improved bottom line for participating businesses because they have healthier employees. As our clinically integrated network progresses, we will have the data showing how we have been able to improve care for members of our community.” Darlow continues, “Because health insurance companies pay the medical claims, they can provide doctors and care managers in the local health-care system with the data necessary to group local patients into low-, moderate-, and high-risk classifications. The people in the highest risk category are the ones who require the most health care, use the Emergency Department most often, and have the most hospital admissions and readmissions. If we can help this group of patients become healthier through better management of their health problems, we can improve their medical care and keep costs down at the same time.” they are in the high-risk category. I can now identify those people and work with the CAP care manager to help them maintain better control of their asthma and feel better. And with fewer serious episodes, their health care costs decline. “Clinical integration has broad, sweeping implications and has the potential to affect the entire community in many positive ways,” says Darlow. “Healthier employees mean increased productivity for businesses. Keeping health care local strengthens the entire community, as well. Patient safety increases, communication among physicians improves, and confidence in our entire health care system rises. This becomes a place sought out by patients and new physicians for the excellence of care. It’s important to understand that clinical integration does not ration or put up roadblocks to care,” he adds. “We believe we can utilize our resources here as well as or better than any network in the state. The goal here is optimization of health care resources through collaboration and greater efficiency.” John Rudd and his many colleagues on the medical staff and the medical center’s administrative team are excited about the possibilities the CAP CI Program offers. “Clinical integration is what’s best for our community, and it makes sense regardless of where we end up with healthcare reform,” he says. “It’s about higher quality and more affordable health care. After all, that’s why we’re here.” Cayuga Medical Center at Ithaca The Bottom Line Cayuga Medical Center is the first local employer to sign up for the CAP CI Program. “Using the CI Program, I can take a look at all of my patients who work at Cayuga Medical Center who have asthma,” Darlow explains. “It may be that out of all of those patients, there are three whose asthma is not well controlled and www.cayugamed.org 27 Updates KUDOS Cayuga Heart Institute Continues High Standards The Cayuga Heart Institute has achieved reaccreditation for adult transthoracic and transesophageal echocardiography services, which are critical components of diagnostic cardiac care. Meeting the high standards of accreditation is a major accomplishment, and consistently maintaining those standards for reaccreditation requires a focused team effort. In addition to raising the bar for local cardiac care, Cayuga Medical Center’s affiliation with the nationally renowned Sands-Constellation Heart Institute at Rochester General Hospital ensures seamless access to care for local cardiac patients requiring open-heart surgery and other interventional Upcoming Silver Service Lectures All Silver Service lectures are free and open to the public. They are presented at 2:00 p.m. in the DeWitt Clinton Auditorium at Kendal at Ithaca. February 15 Paul Stefek, MD, Interventional Cardiologist Cayuga Heart Institute at Cayuga Medical Center “Know Your Numbers” March 8 Steven Rogers, MD Gastroenterology Associates of Ithaca “Do I Have Acid Reflux?” April 12 Andrew M. Jordan, PT, DPT, OCS Department of Physical Therapy, Cayuga Medical Center “The Aging Shoulder: A User’s Guide” May 10 Douglas MacQueen, MD, Infectious Disease Cayuga Medical Associates of Ithaca “HIV Update” June 14 Amy MacQueen, MD Cayuga Medical Center Sports Medicine and Athletic Performance “Treating the Pain of Osteoarthritis” July 12 Eleanor Liebson, Occupational Therapist Department of Physical Therapy, Cayuga Medical Center “Therapeutic Yoga for All Ages” 28 WINTER 2013 / Health Visions procedures not performed locally. The Sands-Constellation Heart Institute was recently ranked number one for cardiac care in New York State. Local Physician Recognized On National Philanthropy Day, Cayuga Medical Center medical staff member Dr. Ann Costello was honored as Volunteer Fundraiser of the Year. “Women Swimmin’ for Hospicare” began nine years ago as the result of a conversation between Dr. Costello and Cornell professor emerita Joan Jacobs Brumberg. Since its inception this annual event has raised over $2 million, with Dr. Costello recognized as a top fundraiser every year. We join the community in expressing our gratitude to Dr. Costello for her inspiring leadership and her commitment to the availability of outstanding hospice and palliative care services right here in Tompkins County. Imaging Services Earns Accreditation The American College of Radiology (ACR) has once again accredited the Department of Imaging Services for all five CT (computed tomography) scanning systems at Cayuga Medical Center and its Convenient Care Centers in Ithaca and Cortland. This accreditation means that our imaging department meets or exceeds ACR’s high performance standards for diagnostic and interventional CT scans. MATERNAL-CHILD UNIT HEALTH WORKSHOPS Our maternal-child care experts offer monthly workshops to the public on a variety of important topics. Call (607) 274-4408 for information and to register. Fees are $15–25 per family unless otherwise indicated. Expectant Parent Workshops: Daylong program. Fee $75 per family. Siblings Are Special: For children ages 3–8 years who are about to become big brothers and sisters. Breastfeeding Plan for Success: For new and experienced moms and their partners. Infant Care and Safety Class: The basics of care, feeding, and safety of your baby in the first few weeks. CAYUGA CENTER FOR HEALTHY LIVING If you are looking for help in making medically necessary lifestyle changes, check out the Center for Healthy Living (CCHL) at the Island Health Center. Classes at CCHL include: Cardiovascular Disease Prevention & Cardiac Rehabilitation: To help people with cardiacrelated medical conditions learn strategies to improve these conditions. This program includes supervised exercise, dietary counseling, stress management, and education about your disease and its medical management. Medically Supervised Exercise (MSE): Exercise guidance for people who have difficulty being active due to chronic medical conditions. Aquatic Medically Supervised Exercise: To improve strength, flexibility, balance, and cardiovascular endurance in the buoyancy of water. The program will also assist you in developing your own independent aquatic exercise routine. Swimming experience is not necessary. OptifastВ® Weight-Loss Program: A twelveweek meal-replacement program that combines weekly clinician visits, ongoing education, and support to help participants achieve and maintain long-term weight loss. If you are serious about losing weight, don’t wait! Healthy Living 101: To learn basic principles of lifestyle management for disease prevention, and to help control type 2 diabetes. Tobacco Cessation: To help you quit your habit. Tobacco cessation support groups are offered on a monthly basis for anyone who is thinking about quitting, is ready to quit, or is trying to maintain being tobacco free. Join in, no matter where you are on your quitting journey. Healthy Living with Type 2 Diabetes: To learn to use the principles of lifestyle management to help control type 2 diabetes. Call (607) 252-3590 for CCHL class dates, information, and fees. Diabetes Education Classes: To learn and practice the skills you need to manage diabetes. House Calls Reconstructive Surgery Following Mastectomy David Monacelli, MD Dr. David Monacelli is a board-certified plastic surgeon on the medical staff of Cayuga Medical Center. He completed his plastic surgery residency at Yale University and has extensive experience in both reconstructive and cosmetic procedures of the breast. In this issue of Health Visions Dr. Monacelli provides our readers with a brief overview of breast reconstruction following a mastectomy. For more in-depth information or for a consultation, he can be reached at (607) 266-0483. Q: What is a mastectomy? A: A mastectomy is the surgical removal of the breast, including all of the breast tissue, typically the nipple and areola, and various amounts of skin. This surgery is performed to treat breast cancer, and in certain highrisk patients it may be performed to prevent breast cancer. Q: Is breast reconstruction after mastectomy common? A: In the recent study of a national database of patients undergoing total mastectomy between 1998 and 2008, researchers confirmed that more women are now choosing immediate breast reconstruction following total mastectomy. While historically only 25 percent of women opted for immediate breast reconstruction, today that figure is 38 percent. Q: At what point should a woman with a breast-cancer diagnosis consult with a plastic surgeon? A: I recommend that patients considering breast surgery to treat cancer see me as soon as possible. If you and your general surgeon are deciding between a lumpectomy and a mastectomy, consultation with an experienced plastic surgeon can help you determine what feels right for you. The decision to have breast reconstruction is extremely personal. You have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. A plastic surgeon can help you in this process. Q: Are there different choices to be made regarding breast recon- struction? A: Yes, there are different surgical procedures and timelines to consider. Some women choose immediate breast reconstruction following mastectomy, while others choose to delay reconstruction. In my experience, patients who undergo immediate reconstruction are usually happiest with the results. There are also different surgical approaches to breast reconstruction. The two most common techniques for reconstructing a new breast mound are implant reconstruction and TRAM-flap reconstruction. Q: What are the pros and cons of implant reconstruction? A: The major advantage of implant reconstruction is that it is a simpler surgery than TRAM-flap reconstruction and patients recover more easily. One of the drawbacks of implant reconstruction is that it requires several office visits over time, as the skin and chest muscle are expanded to create space for the final implant. Another consideration is that in many cases additional revisions may be necessary over time to correct implants that have ruptured, leaked, or become wrinkled. Saline and silicone implants are both available for reconstruction. Q: What are the pros and cons of TRAM-flap surgery? A: TRAM-flap surgery uses a woman’s own skin, fat, and muscle from the abdomen to reconstruct the breast. The advantages are that the breast mound is made of natural living tissue and once the reconstruction is done, additional revisions are uncommon. The drawbacks are that this is a much bigger surgical procedure than implant reconstruction and patients take longer to recover. Additionally, women who smoke or who have diabetes or high blood pressure are not good candidates for TRAM-flap surgery because these complications adversely affect blood flow and healing. Q: Which type of breast reconstruc- tion is most common today? A: When I established my practice here nineteen years ago, I introduced TRAM-flap reconstruction to the area. This was the preferred method of reconstruction at that time. However, today more women are choosing implant reconstruction over TRAM-flap surgery due, in part, to multiple advances in implant reconstructive surgery over the years and the rerelease of silicone gel implants by the FDA for general use. We now have very good evidence that the silicone implants in use today are quite safe. NEW PEDIATRIC CARE AT CAYUGA MEDICAL CENTER Seeing patients evenings and weekends To better meet the needs of our community, we offer after-hours outpatient pediatric and adolescent care (infant to 17 years old) in a clinic setting. Kids Care is staffed by our local pediatricians from Buttermilk Falls Pediatrics and Northeast Pediatrics and Adolescent Medicine, and by registered nurses who are experienced in the care of sick babies and children. When to go to ? Walk-in facility for minor illness or injury, such as: •Fevers •Virus and flu symptoms •Vomiting, nausea, diarrhea, abdominal pain •Sore throat, cough, difficulty breathing •Ear and eye problems •Headache •Head injury •Falls and minor injuries •Skin complaints •Sprains and strains •Puncture wounds and animal bites •Rash •Possible allergic reactions •Tick bite •Asthma Kids Care hours Monday – Friday Saturday Sunday 5:00 p.m. to 9:00 p.m. Noon to 6:00 p.m. 10:00 a.m. to 6:00 p.m. Kids Care Pediatric Services Cayuga Medical Center 101 Dates Drive Ithaca, New York 14850 Directions: From the Cayuga Medical Center main lobby or 1st floor visitor lobby, follow signs and take elevator to the 3rd floor. All other serious medical emergencies, go to the nearest Emergency Department or dial 911. www.cayugamed.org
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